IDz Block 3 Cram Flashcards
What happens during the prodromal period of rabies infection?
What occurs during the acute neurological period?
What finding during the neurological period is pathgnomonic
Virus enters CNS
Pain/paresthesia= pathognomonic Dx
Furious rabies
Paralytic rabies
Hydrophobia
Aerophobia
What is the passive immunization for rabies Tx
How often is rabies booster recommended?
HRIG 20IU/kg in gluteus away from bite
CDC- 2yrs
WHO- 1yr for oversea operators
What may be the first sign of septic arthritis in PTs w/ RA?
What are the two types of osteomyelitis
Septic bursitis
Acute/Chronic
Acute- w/in 2wks bacteria deprive bone of blood, causing necrosis
Chronic- repeat infections and dec blood supply prevent ABX reaching site
What ABX is used for PTs w/ osteomyelitis after nail punctures through shoes?
Define Rickettsiae orgnaism
Cipro
Between bacteria/virus, obligate intracellular Gram-neg coccobacilli
What ABX is used for PTs w/ osteomyelitis after nail punctures through shoes?
Cipro
Since Rickettsiae don’t stain well w/ gram stain, how are they stained for identification?
Rickettsiae are usually transmitted to humans by arthropods except for ?
Red w/ Giemsa
Q fever
Rickettsial Dzs have ? commonalities?
Different types of Rickettsial Dzs
Dx w/ serology/PCR Rash Zoonotic Involve endothelial lining Tx w/ Doxy
Brill Zinsser Louse borne Murine Typhus RMSF Q-fever
Louse Borne Typhus is caused by ? and transmitted by ?
This form is becoming resistant to Doxy in Thailand, what med is used now?
Caused- R Prowazekii
Carried- P Humanus
Azithromycin
How does Louse Borne Typhus present?
What is the sequence of the rash progression?
Intractable HA
Rash from trunk to extremities (opposite of RMSF), spares face palms soles
Macules Maculopapules Petechiae
? is a relapsing louse borne typhus
How does it present
Brill Zinsser
Fever Transient rash HOTN
M Typhus is AKA ?
What causes this strain?
What is it’s carrier?
Endemic/Flea borne typhus
R Typhi
Rat flea
What is the biggest differential between Murin and Louse borne typhus?
What causes RMSF?
What is it’s carrier?
Brill Zinsser
R Rickettsii
Wood/dog ticks
What is the day to day progression of a Rickettsial Dz
1-2: abrupt high fever/HA
2-4: rash on wrist/ankle, spreads centrally
5-7: high fever, rash become petechial involving palms/soles
7-9: digit necrosis, death AMS
What will lab results of Rickettsial Dz show?
How is it Tx?
HypoNa
Inc transaminase
Thrombocytopenia
Doxy, best if started <5 days of Sxs
What causes Q-fever
This has been re-classified as a ? microbe
C Burnetti
Proteobacteria
What is the mainstay of Dx Rickettsial Dzs
What causes Lyme Dz
What is it’s carrier?
Serology cross reactivity
Spirochete- B burdorgeri
Ixodes- deer tick
What is the characteristic PE finding of Lyme Dz
What are the S/Sxs of early disseminated Lyme dz
Lyme Dz can cause ? manifestations of cranioneuropathy
Erythema Migrans
Multiple EMs
Meningismus= eseptic meningitis
Carditis- AV blocks
CN7, Bells
If Lyme Dz PT develops late dz arthritis, how does it start out
What joints are most to least likely affected
Most PTs exhibit these Sxs within ?mon of Erythema Migrans and resolve w/in ?
Migratory polyarticular process
Knee Ankle Wrist
6mon
10yrs
If Lyme Dz PT develops late dz arthritis, how does it start out
What joints are most to least likely affected
Most PTs exhibit these Sxs within ?mon of Erythema Migrans and resolve w/in ?
Migratory polyarticular process
Knee Ankle Wrist
6mon
10yrs
What are 3 possible long term outcomes that can arise from late Lyme Dz arthritis
If PT has Lyme and is pregnant, what meds are not used?
How should these PTs be educated?
Meningoencephalitis
Fibromyalgia
Chronic fatigue
Chronic neuropathy
Doxy
Tetracyclines
No birth defect, risk of still birth
How is Lyme Dz Tx
Bite w/ engorged tick: Doxy
Arthritis: Doxy
Palsy: Doxy
Tick, non-endemic: no Tx
Erythema Migrans: Doxy/Amox
Carditis: Doxy/Ceftriax
Meningitis: Ceftriax
Pregnant: Amoxicillin
How is Lyme Dz Tx
Bite w/ engorged tick: Doxy
Arthritis: Doxy
Palsy: Doxy
Tick, non-endemic: no Tx
Erythema Migrans: Doxy/Amox
Carditis: Doxy/Ceftriax
Meningitis: Ceftriax
Pregnant: Amoxicillin
How is encephalitis Dx
What sample is essential for Dx
Head CT w/ and w/out contrast but before LP
CSF
Where does HSV lie dormant prior to causing HSV encephalitis
How does the virus reach the CNS
This form of latent HSV is not associated w/ ?
Trigeminal ganglia
Olfactory tracts
Cold sores
Where does HSV lie dormant prior to causing HSV encephalitis
How does the virus reach the CNS
Trigeminal ganglia
Olfactory tracts
What are the subacute form of HSV Encephalitis
This can also produce ? inconvenient issue?
Anterior opercular syndrome- benign recurrent meningitis, loss of facial/chewing muscles
HSV-1: brainstem encephalitis
HSV-2: encephalitis induced myelitis
Global aphasia
How is encephalitis Dx
How is it Tx
PCR
CT- low density lesions in temporal lobes on day 3-4
Acyclovir
Majority of Arbovirus encephalitis is ? type
How does Arbovirus encephalitis present differently?
What will be seen on labs?
West Nile
Dys/pyuria
Seizures
Movement d/o
Leukocytosis
EEG changes
Majority of Arbovirus encephalitis is ? type
How does Arbovirus encephalitis present differently?
West Nile
Dys/pyuria
Seizures
Movement d/o
How does West Nile Encephalopathy present?
How is it Dx
Extreme lethargy
Flaccid paraylsis
Leukpenia and serology
What are the 3 major pathways meningitis establishes an infection?
What 3 microbes cause bacterial meningitis
What microbe causes meningitis in adults and kids?
Bloodstream
Retrograde neuron pathway
Direct spread
H Influenza
N Meningitidis
S Pneumoniae
S Pneumoniae
What meningitis triad presents in most PTs
What do PTs present w/ if there is cerebellar dysfunction
Fever
AMS
Nuchal rigidity
Lethargy
Confusion
Coma
What are the two PE tests for meningitis
How do geriatric PTs w/ meningitis present differently
What is a subtle Sx of meningeal infection that may be seen?
Kernig
Brudzinski
Lethargic, no meningeal Sxs
Neutropenia
What are the two PE tests for meningitis
Kernig
Brudzinski
How is Step Pneumo meningitis Tx
What vaccine prevents this?
Cefotax/Ceftriax + Vanc + Dexameth
PCV 13
What is the MC causes of meningitis in neonates
How is Step Pneumo meningitis Tx
What vaccine prevents this?
GBS
E Coli
Listeria monocytogenes
Cefotax/Ceftriax + Vanc + Dexameth
PCV 13
What type of microbe is N Meningitidis
What presenting finding does it have and puts PTs at risk for ?
What PT population is more susceptible to being infected?
Gram neg diplococcus
Petechial rash
Amputations
Asplenic
How many serogroups of N Meningitidis are there?
Which one is more common in the US than out of it
How are they Tx
A B C W X Y
B
Cefotax or Ceftriax + Vanc + Dexameth
What is the criteria for close contact of N Meningitidis
What meds are used for post-exposure prophylaxis
> 8hrs of contact
<3ft away
Direct PO secretion exposure
W/in 1wk before Sx onset
Ceftriaxone 250mg IM x 1or
Rifampin 500mg PO bid x 4
Cipro 500mg PO x 1
What is the criteria for close contact of N Meningitidis
What meds are used for post-exposure prophylaxis
> 8hrs of contact
<3ft away
Direct PO secretion exposure
W/in 1wk before Sx onset
Ceftriaxone 250mg IM x 1or
Rifampin 500mg PO bid x 4
Cipro 500mg PO x 1
What are the 5 types of fungal infections that can cause meningitis
What are the two ‘special’ causes
C neoformans C immitis B dermatidis Candidiasis H capsulatum
TB Syphilis
What are the 3 proteinaceous infections?
What is an odd method of acquiring prion related Dzs
Kuru Jakob Bovine spongiform
Inherited
When do prion dzs present
How are these dzs Dx
6-7th decade as progressive dementia
MRI- bilateral areas of increased density
CSF- inc protein
What is the MC microbe in cat bites?
What is the MC microbe in dog bites?
Pasturella multocida
Capnocytophaga conimorsus
What microbe causes CSDz
This microbe is the MC cause of ? in Peds
It is also the MC cause of ? Sx
Bortonella henselae in fleas
Chronic adenopathy
Regional adenopathy
What is the classic presentation of CSDz
What nodes are most likely to present w/ lymphadenitis
Half of PTs can present w/ ? odd presentation
Rash
Lymphadenitis
Axillary
Cervical submandibular preauricular
Single node involvement
Atypical presentations of CSDz can present as ?
CSDz manifestations may be slow to appear and take ? long to disappear
Encephalitits
+12mon
How is CSDz Dx confirmed
How is it Tx
Serology
Sx therapy
Azithromycin
What causes Toxoplasmosis
How is this infection transported and disseminated
Toxoplasma gondii
Transport- lymphatics
Disseminated- hematogenously
How does Toxoplasmosis kill AIDS PTs
What does it present like in healthy PTs?
What is the MC congenital presentation
Encephalitis- MC manifestation
Mono-like
Chorioretinitis
How is Toxoplasmosis Dx
What are the four atypical mycobacteriums
Organisms in any fluid/tissue
CT if cerebral
Amniocentesis 20-24wks if congenital
Marinum
Ulcerans
Leprae
Chelonae
M Marinum rarely causes systemic infections except for in ? PTs
If deeper involvement occurs, how can this present?
ImmComp
Tenosynovitis
Septic arthrits
How is M Marinum Dx
PTs w/ this can have what issue during PHA?
Culture 25-32C/77-89.6F
Photochromogenic- white in darkness, yellow in light
False Pos on PPD
How is M Marinum Tx
M Ulcerans is AKA ? Ulcer and is found where?
Clarithromycin/Rifampin + Ethambutol x 6mon
Buruli from Africa/Australia
M Ulcerans is the MC ?
How is it Dx
How is it Tx
3rd MC mycobacteriosis of humans after TB and Leprosy
Acid fast smear
PCR
Rifampicin and Clarithromycin/Moxifloxacin x 8wks w/ debrisment/grafts
M Leprae is AKA ? Dz
How is this transmitted
Leprosy, Hansen Dz
Respiratory from foot pads of armadillos
How will PTs w/ M Leprae present
What finding is highly suggestive of this Dx
Ulcer w/ dec sharp/dull sensation
Ulnar neuropathy
How is M Leprae Dx
How is it Tx
Skin biopsy/Nasal scrapings- acid fast bacilli
Rifampin Dapsone and Clofazimine x 12mon
M Chelonae is associated w/ ? animals?
This infection is associated w/ ? hobby?
Frogs/Turtles
Tattoos
How does M Chelonae present
How is this Tx
Plaques Erythema Violaceous Edema
Tobracycin or Clarithromycin x4-6mon if deep
What is the MC zoonosis in the world?
This is now considered a ? in travelers
How is this infection acquired?
Spirochetes of Leptosporosis
Emerging disease
Contact/exposure to infected soil/water/animal
What are the two syndromes from a Leptospirosis infection
The type of infection a PT will develop depends on ?
Anicteric lepto- mild flu-like
Icteric- Weil Dz, organ failure
Serovar involvement
What are the classic findings of Weil Dz (Leptospirosis)
How are Leptospirosis infections Dx
How is the extent of organ involvement assessed?
Calf/Lumbar muscle pain
Isolation from tissue/fluid, typically urine
CBC
Liver panel
Coag studies
How are in/out PT Leptospirosis infections Tx
Define Protozoa
In- IV PCN G
Out- PO Doxy
Motile, unicellular, eukaryote
What are the 7 types of Protozoa infections
Giardiasis Crypto Toxo Malaria
Lesihmaniasis Amebiasis Babesiosis
What causes Amebiasis
What can this cause to develop within the body?
What effect does the microbe have on tissues?
Entamoeba Histolytica
Liver abscess, M>F
Induces self destruction
Trophozoites colonize in colon
Amebiasis can present w/ ?
How does liver abscess present differently than a single abscess
If PT is Dx w/ Amebiasis, what will they probably have in their MedHx
Amebic colitis
Fistulas, rectovaginal
Liver- pain, no fever
Single- weight loss
Dysentery
How does Amebic Colitis present
How does Amebic Liver abscess present
Heme +stool
Fever
Weight loss
Diffuse abdominal tenderness
Hepatomegaly Jaundice Fever Weigh loss RUQ tenderness
How is Amebiasis Dx
How does this look on US
How does it look on CT
EPP PCR
Homogenous hypoechoic round lesion
Round low attenuation lesion w/ enhanced rim
How is Amebiasis Tx
Tissue Tx: Metronidazole
Tinidazole
Lumen Tx: Iodoquinol Paromomycin
Surgery for fulminant amebic colitis
What is the MC parasite identified in stool specimens
Why/how does this cause malabsorption
How is it Dx and Tx
G Lamblia
Alters epithelial function
Causes villous atrophy
Cytopathic secretion
EPP PCR
Tinidazole
Metronidazole
What are the two sub-acute infections of cutaneous leishmaniasis
What is the carrier of Leishmanisis
Leishmaniasis recidivans- prolonged relapsing form
Post kala azal dermal Leishmaniasis
Lutzomyia longipalpis- Sand flies
How does cutaneous Leishmaniasis present
What is the Wet Pizza
What is the Dry
Raised edge, central crater w/ regional lymphadenopathy
Wet- L Major
Dry- L Tropica
Visceral Leishmaniasis is AKA ? and can present w/ ? rash
Where does it infect in the body?
Kala azar or Black Fever
Malar
Liver Spleen Marrow
Spleen bigger than liver
What PE finding is characteristic of Visceral Leishmanisis?
What is a common lab result?
Darkening of skin
Pancytopenia
How is Leishmanisis Ds
What are the criterias for Mild Leishmanisis
Tissue isolation, Giemsa stain
< 4 lesions
None >5cm
None on sensitive areas
No joint involvement
How is mild Leishmanisis Tx
How are other cases Tx
Paromomycin
Liquid N2
Impavido- Txs all forms
Fluconazole- cutaneous
Amphotericin B
ThermoMed radio frequency heat
What are two rare PE findings during a Crypto infection?
How is it Dx
How is it Tx
Icterus
Ascites
EPP PCR
Nitazoxanide
ImmComp- HARRT therapy
What causes Babesiosis
It’s transmitted by ? and produces a ?
What type of microbe is this
B microti- US
B divergens- Europe
Tick vectors, malaria-like illness
Intraerythrocytic protozoan
Babeiosis Sxs are due to ?
What are the presenting Sxs
Secondary to RBC parasitims
Paroxysmal malaria
Fatigue- depends on hemolytic anemia
? PT population has a worse prognosis if they contract Babesiosis
How can it be transmitted between humans?
Asplenic
In utero
Blood transfusion
How is Babesiosis Dx
What lab finding is pathognomonic
How is it Tx
Wright/Geimsa stain
Maltese cross
IgM IFA titer 1:64
Atovaquone + Azith
Clinda + Quinine- if severe
Exchange transfusion
What causes malaria?
Define Archaic
Majority of malaria deaths are due to ? strain
Plasmodium, carried by Anopheles
Bad/foul air, miasma
P Falciparum
Of the 156 types of malaria, which ones infect humans
P falciparum
P vivax
P ovale
P malariae
P knowlesi- Simian malaria; recently found in SE Asia
What are the 4 factors that determine malaria occurrence
Which strain is most wide spread
Which one is primarily in tropical west Africa?
Where are the two remaining found?
Climate- >77*, <6Kft
Human
Anopheles
Parasite
Vivax
Ovale
Falci/Malaria- sub/tropics
What form of malaria resides during the liver phase?
What occurs during the erythrocyte phase?
Sporozoites
Rupture of infected RBCs= fever/merozoite release
What forms of malaria have a hypnozoite form that lingers for months?
Why are these two commonly seen reoccurring later?
Vivax, Ovale
Failure to Tx hypozoites
What are the incubation periods for the different strains of malaria
Which one doesn’t have a hypnozoite stage which means this one will cause ?
Falciparum 12d
Vivax 14d
Ovale 17d
Malariae 28d
Malariae, prolonged erythrocytic infection
How long are the paroxysms between the different types of malaria
What is the sequence of a malaria febrile attack
Why are these sequences important
48hrs: Falci Vivax Ovale
72hrs: Malariae
Cold x 15-60min
Hot x 2-6hrs- HA
Sweat x 2-4hrs
Blood draw during fever spike, highest parasite load
Why is M Facliparum so bad?
Microvascular sequestriation Dz
Hyperparasitemia >250K/5%
Targets all RBCs while other strains target reticulocytes
Dec Hgb/Hct x 8-10% in 48hrs
What are 4 severe manifestations of malaria
What forms can cause splenic rupture in pregnant PTs
Cerebral malaria
Severe anemia- Falciparum
Renal failure- Malariae
Pulmonary edema
Vivax/Ovale
What lab result is absent in malaria infections
What lab results indicate a poor prognosis
Eosinophilia
Cr >3mg Acidosis <15mm Jaundice, total bili >2.5 Lactate >5mm Glucose <40 Aminotransferase 3x inc
What hematological features of malaria indicate poor prognosis
How is malaria Dx
Parasitemia
5% or more neutrophils w/ malaria pigment
Thin and Thick smears 12-24hrs apart
What is the different benefits of thick/thin smears when Dx malaria
What is the alternate Dx form for malaria
Thick- sensitive
Thin- speciation
Dipstick- LDH of Falciparum
BinaxNOW for Falciparum, Vivax but neg reads must be confirmed w/ thick/thins
BinaxNOW rapid malaria tests have hard time maxing Dx if strain of malaria has low amounts of ? Ag
Why are malaria prevention methods not adhered to by PTs
HRP2
GI s/e
Forget
Low perception of risk
What meds are used pre/post-return from malaria country
Doxy- s/e sun burns
Atovaquone/proguanil- 7d post
Primaquine- 14d post/terminal
Chloroquine- CNS side effects
Tafenoquine
What drug is used for malaria PART
What drugs are used for eradicating Vivax/Ovale liver stages?
What drug is used if these lead to relapse?
Primquine for P Vivax relapse
Primaquine phosphate
Tafenoquine
What drugs are used as uncomplicated malaria Tx if it’s chloroquine sensitive
What drugs are used if it’s chloroquine resistant
Aralen- chloroquine phosphate
Quinin sulfate + Doxy
Malarone- atovaquone proguanil
Coartem- artethemere lumefantreine
What drugs are used for Tx of P Falciparum
What monitoring is done while Tx malaria
What monitoring result indicates Tx isn’t working
IV Artesunate
Smears q6-12hrs
Load doesn’t fall x 75% in 48hrs,
Blood not parasite clear in 7 days
What medication is avoided in Tx of certain malaria
What strain is more likely to reinfect?
What strain is more likely to have low level infection?
Steroids, worsen cerebral malaria
Falciparum
Malariae
Two times you’ll see eosinophilia in lab results
What are the Cestodes
Allergies
Helminth infections
Tapeworms: Hymenolepiasis Solium Saginata Latum
? is the MC of all cestode infections?
What is another form but less frequent
H Nana
H Diminuta
How are Hymenolepiasis infections acquired?
Where does it reside in the body
What are two rare PE findings
F/o
Villus
Abdominal tenderness
Urticaria
? form of Taeniasis is less frequently Sx
What is the most striking feature and main Sx
Migrating Taeniasis can cause ?
T solium
Passing of proglottids
Appendicitis
Cholangitis
PE findings more common in kids/adults who have Taeniasis infections
Where is Cysticercosis seen in US?
Weight loss- kids
Subcutaneous nodule- adults
SoCal, 10% of seizures
Asplenic PTs are more vulnerable to what 2 infections?
PT presents w/ subcutaneous nodules, what Dx needs to be r/o?
N Meningitidis
Capnocytophaga canimorsus
Cysticercosis
What 4 microbes can cause anemia like issues
Babesiosis- hemolytic
D Latum- Megaloblastic
Hookworm- IDA
M Falciparum
CSF findings
O W G P
B: U PMN D U
V/AM: N U N N
TB/C: U U D U
Cestodes includes ? and how are they Tx
Tapeworms Hymenolepsis T Solium/ Saginata D Latum Praziquantel
Cystic- DOC
Trematodes includes ? and how are they Tx
Schistosomiasis- HJM
P Westernmani
Praziquantel
F Hepatica- Triclabendazole
Trematodes are hermaphrodites except for ?
Acute Schistosomiasis is AKA ?
Etiology is believed to be due to ?
Schistosomas
Katayama Fever- Mansoni/Japon
Serum sickness reaction
What microbes are Dx w/ Giemsa stain
Best way to Dx S haematobium
Babesiosis
Rickettsia
Leishmaniasis
Urine sample between Noon-3pm
Where does F hepatica mature in the body
How do human get this infection?
Bile duct
Consumption of raw watercress
What do the acute/chronic phases of F hepatica represent?
This has been linked to causing ? in Vietnam vets
Acute- migratory
Chronic- obstruction/tumor Sxs
Colangiocarcinoma
What is the MC species of the ten Paragonimus’ that infect humans?
What is unique about this microbe life cycle?
P Westermani
Unembryonated eggs leave human
Reacquired through consumption of crayfish/crabs
What are the nematodes and how are they Tx
Helminths:
Strongyloides
CLM
Ivermectin/Albendazole
Hookworm Acariasis Toxocariasis Enterobiasis Trichisellosis Mebendazole/Albendazole
What is the MC helminthe in the world?
What is the MC helminthe in the US?
Ascariasis
Pinworm- E Vermicularis
What two nematodes can cause Loefflers Syndrome
What is the 2nd MC nematode in the world and what are the two types?
Strongyloidiasis
Ascariasis
Hookworm: Duodenal/Americanus
What is the largest intestinal nematode?
? is AKA Human Pinworm
How is it Tx
Ascaria lumbricoides
Enterobius vermicularis
Mebendazole
What is are two rare but possible consequences of Enterobiasis vermicularis infections in females?
What is the MC tropically acquired dermatosis?
Appendicitis
Chronic salpingitis
CLM- Ancylostoma caninum
What causes Toxocariasis
This can cause what two issues?
T canis- dog roundworm
T cati- cat roundworm
Visceral larva migrans
Ocular larva migrans
Toxocariasis OLM can be mis-Dx as ?
How would you differentiate between this mis-Dx and a helminthe infection?
Retinoblastoma (leukoria)
OLM has hypereosinophilia
How are Trichinellosis infections acquired
What are the 4 types and origins
Consumption carnivore meat
Pseudospiralis- mammal/bird
Nativa- arctic bears
Nelsoni- African predators
Britovi- Europe/Asia carnivores
How do Trichinellosis infections present?
What are 3 life threatening manifestations that can occur?
What is added on top of Mebendazole/Albendazole Txs?
Facial edema
Fever
Splinter hemorrhage
Myocarditis
Encephal/meningitis
Pneumonia
Steroids
